Last month, for a whole variety of reasons whose snore-worthy detail I’ll spare you, I decided to take on a short course of a ketogenic diet. Unlike most therapeutic diets I recommend, “keto” requires careful adherence—the physiology of this one doesn’t work if you eat off-plan a little here and there. At first glance, this wouldn’t seem to be a good fit for me—I don’t do so great with all-or-nothing anything, especially when it comes to my health. Not exactly the individualized approach I usually strive for. But, looking at the picture painted by the considerable amount of data I have accumulated about my health, Alexis the Clinician was able to convince Alexis the Patient that the potential upside outstripped the drawbacks in this particular instance.
So what to do when doing what you KNOW you know need to do requires overcoming a whole lot of internal resistance? You remove whatever pushback you can. I knew that this fairly fundamental aspect of my personality—not liking all-or-nothingness—was not going to change anytime soon. It was going to be a bit of an uphill climb any way I sliced it, but I could make sure I had the wind at my back, a good road map, and a light pack. I could pick out the foreseeable things that my resistant nature would have taken as an excuse to just give up, and I could take them out of the equation.
So I planned and prepared. And I’m so glad I did! I’m on the other side of it now, and I can say that one of the WORST things I could have done—the thing that almost certainly would have guaranteed that I would have failed before I finished—would have been to just jump straight in. I feel confident that the experience not only left me with greater empathy for what I’m asking my patients to do in their lives, but also a list of strategies that I might be able to apply to future situations about which I’m less than enthusiastic. Here’s how I made keto work for me:
- I gathered the vital details. What would a day in the life of keto look like? What features were really important? Were there things I could let slide a little? What are some of the common pitfalls? Would I need to modify it additionally for any other reason? In my case, I did need a few added facets to tailor traditional keto to fully address my health needs.
- I picked a realistic time. I knew I needed about a month. I know that accommodating multiple dietary restrictions while traveling is difficult, and I travel a fair amount. I looked at my calendar and picked a time when I would be in town for a month solid—which meant waiting more than a month from when I started planning to when I actually started.
- I gathered my resources. I knew I was going to have questions as my time went by and things came up. I found a few reputable, non-dogmatic, well-written places I could go with my questions so I wouldn’t have to re-invent the wheel every time.
- I figured out how I would actually operate in keto mode on a daily basis. This meant:
- Figuring out what foods I could actually eat—not a theoretical list, but things I like and actually WOULD eat.
- Having a few go-to recipes that were either quick or make-ahead. (Hello, pesto over cauliflower “rice”, Jessica Alba’s turkey meat balls, Dr. Woo’s roast chicken, and my favorite tossed salad: arugula/mache/baby kale, pine nuts, avocado, shaved pecorino, cold-pressed olive oil, lemon juice, and black pepper.)
- Figuring out places in my neighborhood that could accommodate my needs with relative ease. I don’t live a life where I can prepare all my own food all the time. That wasn’t going to be changing a whole lot. I leaned heavily on dietary restriction accommodators extraordinaires Hugo’s and Chipotle.
- I practiced a little. Although the whole philosophy of keto is to do it continuously for an extended period, I decided to do a few scattered days of eating this way ahead of time so I would know what it feels like. These trial run days ended up proving immensely helpful in helping me identify what my particular challenges would be before I started my dedicated four-week stint. This way, I got to figure out some of the frustrations beforehand, so that my first time meeting them wasn’t under the pressure of “I have to do this exactly right now because I’m running out of time!”
- I figured out my work-arounds. Using what I learned from my trial days, I was able to put some thought into how I was going to deal with the pitfalls. For example, on second review of my resources, I learned that my occasional mild headache might be alleviated by broth. (It was!) For the non-news flash of “I like sweets”, I found a few things I could include without compromising the plan or relying on my nemeses (artificial sweeteners). This was actually great, since sugar avoidance needs to be part of my long-term management. (Cinnamon, vanilla extract, and full-fat products have earned a new appreciation by me.)
- I thought about the impact on other areas of my life. Date night without alcohol? Dinner out with a more-restricted-than-usual menu? Entertaining in our home with a long list of “not-on-the-menus?” They all actually ended up being fine, but it was helpful to think about ahead of time. We saw more movies with dinner at home, tried a few new recipes, had a few more cook-together dates where we enjoyed our backyard and late summer weather. And here’s a hint: nobody misses eating what you never mention that you’re not serving.
- I decided how I would handle it socially. I’m usually all for my patients disclosing what they’re doing with their health to anyone and everyone around them who might be supportive. But in this case, because it was time-limited and not very reflective of how I’d be eating long-term, I decided I’d disclose on a need-to-know basis only. For the brunch invite to a restaurant I knew could accommodate me: no mention (diet talk, after all, is on the list of seven verboten conversation topics). But for the relatives’ in-home dinner invite: disclosure, with a dignified opt out. (Dinner ended up happening and was wonderful.)
- I decided what my attitude would be. Or maybe, more accurately, I decided what I was going to get out of the experience. I was going to use my four weeks of keto as a backdrop for observing myself. I decided that I wouldn’t try to deny when I was frustrated or not loving it, but observe what I felt, how I behaved in different situations. I could at least be grateful for that opportunity to learn about myself.
And learn I did. For one, I’ve gotten better symptom relief with this than anything I’ve done prior. So Alexis the Clinician was on to something. It’s too soon to re-test the lab work—I’ll have to do the gradual reassimilation process first—but I’m reassured. Aside from that, I got to see a piece of my personality on full display, in a different light. I have a really strong impulse to rebel against too much structure—by doing something completely moderate and reasonable outside that structure. I don’t want to be raging drunk, but I want to have a glass of wine with dinner when we go out. I don’t need a slice of seven layer cake every day, but I missed having regular fruit as a kiss of something sweet in my routine. I can eat plenty of things I like, but there there are plenty of healthy things (lentils! beets!) that I’m looking forward to including again. I’m rebellious, but not wild. Dissident. Which I do believe I like. Here’s to self-reflection.